Basic Information
| Provider Information | |||||||||
| NPI: | 1609429638 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILLBRAE CARE CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13347 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914234267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183853200 | ||||||||
| FaxNumber: | 8183853287 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 MATEO AVE | ||||||||
| Address2: | |||||||||
| City: | MILLBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940302037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506895784 | ||||||||
| FaxNumber: | 6506895946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2019 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | MAYER | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8183853200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.